Western Occupational and Environmental Medical Association
Webinar – June 17, 2010
To Work or Not to Work:
The Costs of Presenteeism and Absenteeism
Speaker: Constantine Gean, MD, MS, MBA, FACOEM
Regional Medical Director, Liberty Mutual Group
PLEASE STAND BY
WEBINAR WILL BEGIN AT 12:00pm
(PDT)
For Audio:
Call: 866-740-1260
Access Code: 7644915#
Faculty Disclosure:
Constantine Gean, MD, MS, MBA, FACOEM has no conflict of interest
to disclose.
To Work or Not To Work
The Costs of Presenteeism
and Absenteeism
Constantine Gean, MD, MS, MBA, FACOEM
Regional Medical Director, Liberty Mutual Group
WOEMA Webinar - June 17, 2010
Learning Objectives
• Understand absenteeism, presenteeism, and differences between the two
• Describe why absenteeism and presenteeism are important concepts for
occupational health practice
• Obtain a general concept of the origins of presenteeism.
• Appreciate absenteeism and presenteeism as they relate to the Workers
Compensation and Group Health arenas.
• Review the economic consequences of absenteeism and presenteeism.
• Obtain an understanding of program approaches to monitoring and
limiting costs from absenteeism and presenteeism.
The Big Picture
The Solar System
“Ideas rather than materials or physical
brawn have been by far the greatest
contributors during the past half-century
to our average annual increase of 3-1/4
percent in real gross domestic product.”
-Alan Greenspan, March 11, 2004
(Before the Committee on Education and the Workforce, U.S.
House of Representatives)
WHAT IS PRODUCTIVITY?
Levels of labor Productivity in 1990 US Dollars
WORKING PAPER NO. 50 - European Central Bank, 2001 http://www.ecb.int/pub/pdf/scpwps/ecbwp050.pdf
“Hang On! I just got another nibble!”
The Perils of Fishing
Intel income statement - analysis of the
value of human capital
• Estimated cost of human capital
• 36% of revenues
• 24% of book value of Companies
• Because of this high cost human capital warrants
significant investment
• On a par with fixed capital costs
• Sending on human capital (some overlap):
•
•
•
•
•
Group health
(47%)
Turnover
(37%)
Unscheduled absences (8%)
Non-occ disability (5%)
Workers’ Comp.(3%)
- Dr. Marc L. Berger VP of Merc Outcomes Research
- Validated by R. Howell, Dean of Dartmouth’s Bus. School
Cost Drivers
• Disability Costs Exceeded $340 million
(Wall St. Journal)
• Disability Costs 8-10% of payroll
(Unum 2002 Study)
• Disability Costs can exceed $2,500 per employee
(DOL/COREl)
PRESENTEEISM
AND
ABSENTEEISM
What are they?
How Measured?
Examples?
Presenteeism Origins
• Presenteeism is the opposite of absenteeism
– Presenteeism discusses the problems faced when employees
come to work in spite of illness, which can have similar
negative repercussions on business performance
• Issue has existed in some form or another for centuries
– Name is relatively new
• Factors and History
–
–
–
–
–
‘40-’50’s EE-sponsored Health Care
GDP Growth + Managed care
Cornell Study, ACOEM, Dartmouth Cost of Human capital
Increased US Longevity
Downsized workforces (increases relative contribution from each EE)
– Workforce Optimization
Presenteeism and Absenteeism –
Unions’ and Employers’ Perspectives
• Presenteeism often cited cause –
• Fear of loss of income or employment on the part of the
employee
– Over 59 million American workers (nearly half of the workforce) do not have
access to paid sick days
– Nearly 80% of low-income workers do not have access to paid sick days
– On average, workers need 1.8 sick days/year to care for themselves and 4
days/year to care for sick children
• Trade Unions’ Perspective –
• Presenteeism has developed as a result of a gradual relaxation of employment
protection laws and reductions in benefits, most notably sickness benefits
• Employers' Perspective –
• Other factors are contribute to presenteeism, including an increase in health
care costs, which has rendered employees more reluctant to seek medical
attention when it is necessary
Lovell, 2004 - IWPR publication B242
Most Relevant Conditions Impacting
Productivity Change Based on POV
(Top 10 Medical Conditions From Various Perspectives )
JOEM • Volume 49, Number 7, July 2007
Medications Can Compound Problems
Est. Annual Cost of Presenteeism
(employed Population @ $23.15/hour)
Goetezel, et. Al., JOEM Volume 46, Issue 4, pp398-412 (April 2004)
Absenteeism
• DEFINITION: A habitual pattern of absence from a
duty or obligation
– Traditionally viewed as poor individual performance
– Seen as a management problem
– Framed in economic or quasi-economic terms
– More recently seen as an indicator of psychological,
medical, or social adjustment to work
• Short Term Disability
– Generally 50% of absences are < 2 weeks, and 50% are
> 2 weeks
Commonly used Days Away from Work
(DAFW) Approach
700,000
600,000
Combined Operations & Maintenance Absence Costs 1996 - 1998
$ 30,067
$ 19,139
$ 25,369
$ 18,395
TMW Dollars Spent
500,000
$ 203,422
$ 200,907
$ 260,606
$ 13,612*
$ 225,345
400,000
$ 188,099
300,000
Maint. OT
Cost
$ 207,066
$ 200,253
$ 139,542
Oper OT
Cost
$ 127,063
200,000
$ 99,244 *
Maint STD
Direct Cost
100,000
$ 182,918
$ 162,900
$ 162,352
$ 185,840
$ 129,419
0
6/30/1996
12/31/1996
6/1/1997
12/31/1997
6/14/1998
Six Month Period Ending
CONCLUSION: Find low hanging fruit just by adding up DAFW.
Oper. STD
Direct Cost
Spine Pain, Depression and Fatigue Top List
Top 10 Overall Most Costly Medical Conditions
(Annual medical + drug + Absenteeism + Presenteeism costs per 1000 EE)
JOEM • Volume 49, Number 7, July 2007
PRESENTEEISM
AND
ABSENTEEISM
What to do to limit?
How Managed?
Examples?
Approaches to Absenteeism and
Presenteeism Management
Health & Productivity Management
Disability management
Productivity management
Value-based health
care provision
Wellness & Health promotion
Footnotes:
a, b - 2001 Unscheduled Absence Survey. CCH Inc.
c - 2001 Health Value Initiative, Hewitt Associates
MANAGEMENT OF RESOURCES
Expanded View
Health & Productivity Management
Disability management
Issues
• Per-EE abs cost = $755 in ’01a
• Provider RTW role ignorance
• Older workers (LTD incr 4x fr. 42 to 57 yo.)b
• Multiple Health programs
Approaches
Commonly used
• Absence/DAFW mgt. pgms
• Modified Duty pgms
• Rapid medical assmt. & triage
• Preventive Programs
Less commonly used
• formal supervisor RTW training
• setting RTW expectations
• super’s & EE certainty: + training
• keeping in touch with EE
• ALOD Variation, analys & interven.
Productivity management
Approaches
• RTW and Stay at Work programs
• Scope of Work
Wellness & Health promotion
Approaches
• Health Promotion
• Modifiable health risk/HRA pgms.
Value-based health care provision
Issues
• Unreasonable utilization
• Redundant benefits
• Non Evidence-based Treatments
• Multiple Health programs
• Pharmacy spend & misuse
Approaches
Plan approaches
•Appropriate Benefit mix
•Pharmaceutical restrictions
•Defined Contribution Plans
•Reduction/Attenuation of benefits
Clinical Management approaches
• Pharmaceutical Management
• Utilization analysis (Medstat)
• Pre-Authorization ReviewsClinical
• Concurrent Review
• Case Management
• Demand Management
• Disease Management
• Specialty Case Management
• Population Health Management
Footnotes:
a, b - 2001 Unscheduled Absence Survey. CCH Inc.
c - 2001 Health Value Initiative, Hewitt Associates
Backache and Depression Most Prevalent
Conditions (Focus on the most common conditions)
ICD9CODE
Description
Ave
ICD9CODE
Frequency
of
DELIV ERY IN A COMPLETELY NORMA L CA SE
650
2677
4
BA CKA CHE, UNSPECIFIED
LUMBA R SPRA IN
NECK SPRA IN
LUMBA GO
UNSPECIFIED SITE OF SPRA IN A ND STRA IN
SCIA TICA
LUMBOSA CRA L (JOINT) (LIGA MENT) SPRA IN
CERV ICA LGIA
724.5
847.2
847
724.2
848.9
724.3
846
723.1
581
463
394
233
221
180
147
144
1
1
1
1
1
2
1
1
2363
M AJOR DEPRESSIV E AFFECTIV E DISORDER, RECURRENT EPISODE
296.3 , UNSPE103
CIFIED DEGR
2
M AJOR DEPRESSIV E AFFECTIV E DISORDER, SINGLE EPISODE
296.22
, M ODERATE
117
DEGREE
2
NEUROTIC DEPRESSION
300.4
163
2
M AJOR DEPRESSIV E DISORDER, RECURRENT EPISODE
296.3
181
2
M AJOR DEPRESSIV E AFFECTIV E DISORDER, SINGLE EPISODE
296.2
, UNSPECIFIE
197
D DEGREE 2
M AJOR DEPRESSIV E AFFECTIV E DISORDER, SINGLE EPISODE
296.23
, SEV ERE DEGRE
232 E, WITHO
2
M AJOR DEPRESSIV E AFFECTIV E DISORDER, RECURRENT EPISODE
296.33 , SEV ERE
246
DEGREE, W
2
DEPRESSIV E DISORDER, NOT ELSEWHERE CLASSIFIED
311
338
2
M AJOR DEPRESSIV E DISORDER, SINGLE EPISODE
296.2
378
2
1955
ADJUSTMENT REACTION WITH MIXED EMOTIONAL FEATURES
309.28
ANXIETY STATE, UNSPECIFIED
300
GENERALIZED ANXIETY DISORDER
300.02
105
109
141
2
2
2
355
OTHER A ND UNSPECIFIED NONINFECTIOUS GA STROENTERITIS 558.9
A ND COLITIS 147
1
OVERALL UTILIZATION TRENDS - Circulatory Case Types
(ALOD = Average Length of Disability)
Average Duration (LOD)
100
84
76
75 74
65 67
62
58
57 55
53
48
42
49
59
55
59
47 48
47
34
J un-9 9
J ul- 99
Au g-9 9
Sep- 99
Oct- 99
No v- 99
Dec-9 9
J an- 00
Feb-0 0
Ma r-00
Ap r- 00
Ma y- 00
J un-0 0
J ul- 00
Au g-0 0
Sep- 00
Oct- 00
No v- 00
Dec-0 0
J an- 01
Ap r- 99
Ma y- 99
20
Result: 12% ALOD decrease.
43
HIGH IMPACT UTILIZATION TRENDS
- Psychiatric Case Types
(ALOD = Average Length of Disability)
26
Manufacturer - Location Analysis
- ALOD by Location and type (Medical vs MH*)- 4 Qtr Summary(Q3’ 00-Q2’01)
Savings Potential: What’s up with San Jose and Orchard Park?
*MH=Mental Health ICD-9’s
So What Does this Mean from
the Clinician’s POV?
“Oh, the
Pain!”
Implications for the Practitioner
(ID problems and be a good doctor)
• Understand the continuum of Absenteeism and
Presenteeism can help the care of the individual
• Do aggressive treatment of common conditions
(depression, respiratory illness, hypertension)
• Understand/find possible company resources (EAP’s,
wellness programs, special benefits, etc.)
• Encourage employers to use transitional work and
focus on defining employee functional level
Chronic Pain (Biopsycosocial Model)
Loeser J.
Managing the
Chronic Pain
PatientD,, 1989
Implications for the Practitioner
Understand basic disability prevention/management
• Understand the Biopsychosocial Model (e.g., emotional
reactions accompany temporary disability and should be
managed to prevent it becoming permanent).
• Understand that a diagnosis alone (without demonstrable
functional impairment) may not justify work absence
• ID and treat psychiatric issues and teach patients about the
interaction of psychiatric and physical problems.
• Understand Functional Recovery Programs and use them in
cases of delayed recovery
?
WRAP UP AND QUESTIONS
Presenteeism and
Absenteeism Literature
Preventing Needless Work Disability by Helping People Stay Employed – ACOEM Position
Paper - J Occup Environ Med - 01-SEP-2006; 48(9): 97287http://www.acoem.org/guidelines.aspx?id=566
Healthy Workforce/Healthy Economy: The Role of Health, Productivity, and Disability
Management in Addressing the Nation's Health Care Crisis
J Occup Environ Med - 01-JAN-2009; 51(1): 114-9
Health and Productivity as a Business Strategy
J Occup Environ Med - 01-JUL-2007; 49(7): a712-21
Health, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental
Health Conditions Affecting U.S. Employers
J Occup Environ Med - 01-APR-2004; 46(4): 398-412
Thank you for participating in today’s webinar.
At the conclusion of this call you will receive an
email with a link to a post-webinar questionnaire.
You will need to complete this questionnaire in
order to receive CME for this webinar.
This webinar presentation can be downloaded at
www.woema.org